Highly cross-linked versus conventional polyethylene inserts in total hip arthroplasty, a five-year Roentgen stereophotogrammetric analysis randomised controlled trial

Abstract

BACKGROUND Polyethylene (PE) particles produced by wear of the acetabular insert are thought to cause osteolysis and thereby aseptic loosening of the implant in total hip arthroplasty (THA). As highly cross-linked polyethylene (HXLPE) is presumed to give lower wear rates, in vivo studies are needed to confirm this. AIM To compare the wear of REXPOL, a HXPLE, with conventional PE within the first five years after implantation using Roentgen stereophotogrammetric analysis (RSA). METHODS Patients were randomised to receive either a HXLPE (REXPOL) or a conventional PE insert during primary THA. RSA images were obtained directly postoperative and after 6 wk, 12 wk, 6 mo, 12 mo, 24 mo and five years. Functional outcomes were assessed using the Hip Injury and Osteoarthritis Outcome Score and Harris Hip Score at baseline and five years after surgery. RESULTS The HXLPE (REXPOL) showed less wear in the latero-medial direction. Significant wear rates of conventional PE were seen in the latero-medial and center-proximal direction and in volume and corrected volume, whereas the REXPOL did not show these outcomes over time. Improvement from baseline in functional outcome did not significantly differ. CONCLUSION Total 3D wear is less in THAs inserted with a REXPOL inlay than a conventional PE inlay after five years. This study confirms, for the first, that the REXPOL HXLPE inlay is preferred to standard PE.

Highly cross-linked polyethylene still outperforms conventional polyethylene in THA: 10-year RSA results

“…Osteolysis, attributed to polyethylene wear debris, is one of the main causes of aseptic loosening in THA (Jacobs et al 2001). Since highly cross-linked polyethylene (HXLPE) was introduced, several studies have shown reduced wear compared with ultra-high-molecular-weight polyethylene (UHMWPE), hereafter called conventional PE (Kuzyk et al 2011, van Loon et al 2020. Conventional PE liners demonstrate a mean wear rate of around 0.1 mm/year, which has been considered as the generally accepted osteolysis threshold.…”

Short-term and Long-term Complications of Cervical Disk Arthroplasty

“…48,49 Although there is a gap in the CDA literature regarding implant design and its impact on wear, there is extensive literature in adult reconstruction supporting the use of polyethylene polymer, and the use of highly cross-linked ultrahigh molecular weight polyethylene has become the standard of care in total hip arthroplasty. 79,80 Similarly, studies on disc arthroplasty are beginning to show similar trends in wear patterns for metal-onpolymer compared with metal-on-metal designs. [50][51][52] While metal-on-metal designs can decrease the amount of wear debris, they have been associated with metal hypersensitivity and complications leading to implant failure.…”

“…The first 2 to receive Food and Drug Administration approval in 2007 were the Prestige ST, a metal-on-metal design, and ProDisc-C, a metal-on-polymer design 48,49 . Although there is a gap in the CDA literature regarding implant design and its impact on wear, there is extensive literature in adult reconstruction supporting the use of polyethylene polymer, and the use of highly cross-linked ultrahigh molecular weight polyethylene has become the standard of care in total hip arthroplasty 79,80 . Similarly, studies on disc arthroplasty are beginning to show similar trends in wear patterns for metal-on-polymer compared with metal-on-metal designs 50–52 .…”

Future Prospects for Clinical Applications of Nanocarbons Focusing on Carbon Nanotubes

“…Table is modified from a study by Takanashi et al [128] Since ultrahigh-molecular-weight polyethylene (UHMWPE) used in artificial joint sliding elements wears quickly, [132][133][134][135][136][137][138][139][140][141] crosslinked UHMWPE is often used in total hip arthroplasty (THA). [142][143][144][145][146][147][148][149][150][151][152] However, crosslinked UHMWPE has low impact resistance and is hence easily breakable, with several published cases of breakage in THA. [153][154][155][156][157][158][159] For the same reason, crosslinked UHMWPE is avoided for total knee arthroplasty (TKA), which involves the convex contact of joint components.…”